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The mechanism explaining why different patients develop emphysematous or bronchitic phenotypes in the presence of common risk factors is largely unknown

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This review, published in the American Journal of Preventive Medicine in 2014, looked at 76 of the best available studies on e-cigarettes: "Due to many methodological problems, severe conflicts of interest, the relatively few and often small studies, the inconsistencies and contradictions in results, and the lack of long-term follow-up no firm conclusions can be drawn on the safety of [e-cigarettes]." The researchers also found that in 26 of the studies reviewed, the authors had declared a conflict of interest